Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 15 , ISSUE 3 ( July, 2011 ) > List of Articles

RESEARCH ARTICLE

Preoperative predictors of mortality in adult patients with perforation peritonitis

Abhijit Bhattacharya, Ranju Singh, Homay Vajifdar, Nishant Kumar

Keywords : Blood sugar, blood urea, delay, duration of peritonitis, Mannheim peritonitis index, perforation peritonitis, mortality, pH, serum creatinine, serum lactate levels, standard base excess

Citation Information : Bhattacharya A, Singh R, Vajifdar H, Kumar N. Preoperative predictors of mortality in adult patients with perforation peritonitis. Indian J Crit Care Med 2011; 15 (3):157-163.

DOI: 10.4103/0972-5229.84897

License: CC BY-ND 3.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2011; The Author(s).


Abstract

Introduction: There is paucity of data from India regarding the etiology, prognostic indicators, morbidity, and mortality patterns of perforation peritonitis. The objective of our study was to evaluate the predictors of mortality, preoperatively, for risk stratification of the patients and institution of an early goal-directed therapy. Materials and Methods: Eighty-four consecutive patients presenting with perforation peritonitis, in the age group of 14-70 years scheduled for emergency laparotomy were studied prospectively. The parameters studied were age and sex of the patients, associated co-morbidities, duration of symptoms, delay in initiating surgical intervention, and preoperative biochemical parameters such as hemoglobin, random blood sugar, blood urea, serum creatinine, pH, base excess, and serum lactate levels. In-hospital mortality was taken as the outcome. Results: We encountered a mortality of 17.8% in our study. Multiple linear (enter) regression identified the age, duration of symptoms, preoperative blood sugar levels, blood urea, serum creatinine levels, Mannheim Peritonitis Index, and the delay in instituting surgical intervention as independent predictors of mortality. Hyperlactatemia, acidosis and base excess were not found to be associated with mortality. Conclusion: Routine biochemical investigations, delay in presentation, and surgical intervention are good predictors of mortality. Recognizing such patients early may help the anesthesiologists in risk stratification and in providing an early goal-directed therapy.


PDF Share
  1. Ramakrishnan K, Salinas RC. Peptic Ulcer disease. Am Fam Physician 2007;1:1005-12.
  2. Sharma L, Gupta S, Soin AS, Sikora S, Kapoor V. Generalized peritonitis in India- the tropical spectrum. Jpn J Surg 1991;21:272-7.
  3. Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg 2006;1:26.
  4. Ersumo T, W/Meskel Y, Kotisso B. Perforated peptic ulcer in Tikur Anbessa Hospital; a review of 74 cases. Ethiop Med J 2005;43:9-13.
  5. Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg 1994;81:209-13.
  6. Müller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S, Müller AM. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol 2009;44:145-52.
  7. Külah B, Gülgez B, Ozmen MM, Ozer MV, Coºkun F. Emergency bowel surgery in the elderly. Turk J Gastroenterol 2003;14:189-93.
  8. Seo HJ, Park HK, Park YH, Lee HK, Lee WG, Cho SY, et al. Prognostic factors in duodenal ulcer perforation. J Korean Surg Soc 2001;60:425-31.
  9. Cohen MM. Treatment and mortality of perforated peptic ulcer: A survey of 852 cases. Can Med Assoc J 1971;105:263-9.
  10. Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Mortality and Morbidity - Patients With Peptic Ulcer Perforation. J Gastroenterol Hepatol 2007;22:565-70.
  11. Svanes C, Lie RT, Svanes K, Lie SA, Süreide O. Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg 1994;220:168-75.
  12. Vorwerk C, Loryman B, Coats TJ, Stephenson JA, Gray LD, Reddy G, et al. Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J 2009;26:254-8.
  13. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009;37:1670-7.
  14. Joynt GM, Lipman J, Gomersall CD, Tan I, Scribante J. Gastric intramucosal pH and blood lactate in severe sepsis. Anesthesia 1997;52:726-32.
  15. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients. Emerg Med J 2008;25:659-65.
  16. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001;27:74-83.
  17. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. Crit Care Med 1999;27:1577-81.
  18. Notash AY, Salimi J, Rahimian H, Fesharaki MS, Abbasi A. Evaluation of Mannheim peritonitis index and multiple organ failurescore in patients with peritonitis. Indian J Gastroenterol 2005;24:197-200.
  19. Bosscha K, Reijnders K, Hulstaert PF, Algra A, van der Werken C. Prognostic scoring systems to predict outcome in peritonitis and intra abdominal sepsis. Br J Surg 1987;4:1532-4.
  20. Kologlu M, Elker D, Altun H, Sayek I. Validation of MPI and PIA II in two different groups of patients with secondary peritonitis. Heptogastroenterology 2001;48:147-51.
  21. Goris RJ, Boekhorst TP, Nuytinck JK, Gimbrare JS. Multiple- organ failure: Generalised autodestructive inflammation? Arch Surg 1985;44:937-46.
  22. Rogy M, Függer R, Schemper M, Koss G, Schulz F. The value of two distinct prognosis score in patients with peritonitis. The Mannheim Peritonitis Index versus the APACHE Score. Chirurg 1990;61:297-300.
  23. Lee FY, Leung KL, Lai BS, Ng SS, Dexter S, Lau WY. Predicting Mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg 2001;136:90-4.
  24. Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcer: A prospective validation of predictive factors. Ann Surg 1987;205:22-6.
  25. Mäkelä JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg 2002;168:446-51.
  26. Rattarasarn C. Hypoglycemia in sepsis: risk factors and clinical characteristics. J Med Assoc Thai 1997;80:760-6.
  27. Miller SI, Wallace RJ Jr, Musher DM, Septimus EJ, Kohl S, Baughn RE. Hypoglycemia as a manifestation of sepsis. Am J Med 1980;68:649-54.
  28. Riché F, Panis Y, Laisné MJ, Briard C, Cholley B, Bernard-Poenaru O, et al. High tumor necrosis factor serum level is associated with increased survival in patients with abdominal septic shock: A prospective study in 59 patients. Surgery 1996;120:801-7.
  29. Viallon A, Guyomarc′h S, Marjollet O, Berger C, Carricajo A, Robert F, et al. Can emergency physicians identify a high mortality subgroup of patients with sepsis: Role of procalcitonin. European Journal of Emergency Medicine 2008;15:26-33.
  30. McIntyre R, Reinbach D, Cushieri RJ. Emergency abdominal surgery in the elderly. J R Coll Surg Edinb 1997;42:173-8.
  31. Rosenthal RA, Andersen DK. Physiologic considerations in the elderly surgical patient. Modern Surgical Care. In: Miller TA, editor. 2 nd ed. St Louis, MO: Quality Medical Publishing Inc; 1998. p. 1362-84.
  32. Afridi SP, Malik F, Rahman S, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World J Emerg Surg 2008;3:31.
  33. Stagnaro-Green A, Barton MK, Linekin PL, Corkery E, deBeer K, Roman SH. Mortality in hospitalized patients with hypoglycemia and severe hyperglycemia. Mt Sinai J Med 1995;62:422-6.
  34. Shilo S, Berezovsky S, Friedlander Y, Sonnenblick M. Hypoglycemia in hospitalized nondiabetic older patients. J Am Geriatr Soc 1998;46:978-82.
  35. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care 2004;8:R60-5.
  36. Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma 1999;47:964-9.
  37. Morgan TJ, Clark C, Endre ZH. Accuracy of base excess-an in vitro evaluation of the Van Slyke equation. Crit Care Med 2000;28:2932-6.
  38. Ohmann C, Hau T. Prognostic indices in peritonitis. Hepatogastroenterology 1997;44:937-46.
  39. Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D, et al. Prognosis in intra abdominal infections. Multivariate analysis on 604 patients. Arch Surg 1996;131:641-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.